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Muneabudean M

1 reviews | Active since Nov 2019

25 Apr 2024, 06:56

Claims evasion not paid

Having a service provider call you after you sent the account to your medical aid, that is the worst feeling. I had x-rays taken in November 2023 after a nasty fall, it was so easy whent to my doctor explained what had happened got referred to see if anything is broken. Got to the x-ray department they checked benefits came back and enquired if I'm aware of any waiting period, not surprised at all as there is a renal disfunction waiting period of 12 months,but this is for pain due to a fall not anything o do with kidney or blader etc. No problem we will do juat the basic x-rays.... Got it done..long story short doctor got paid but the x-ray account was rejected I have resubmitted this account three times to discovery health with the exact same response. I have sent the account to their Escalations team explaining that it had nothing to do with my renal condition and wow they came back with the exact same response.Now having worked in an escalation position I understand that the claim needs to be assessed and the provider and account holder needs to be informed as to why exactly it is not paid .... These guys are just giving a genetic response not informing myself or the doctor what to do to rectify any error. I would at this point be looking at complaining to CMS and hopefully getting a positive response

0
Replies (2)
Discovery Health
Discovery Health's reply25 Apr 2024, 10:36
Official
Dear Muneabudean M

We’ve noted your concerns and we’re investigating the matter. We’ll contact you with feedback as soon as possible. 

Regards 
Discovery Health Servicing Team
Discovery Health
Discovery Health's reply29 Apr 2024, 11:02
Official
Dear Muneabudean M

Please check your emails for final feedback from us.

Regards 
Discovery Health Servicing Team